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There are other options, Mission, Blue Cross NC tell business group

Reporter Mark Barrett explains the dispute between Mission Health and Blue Cross Blue Shield of North Carolina which could lead to the insurance provider being dropped by the health care provider in October.

ASHEVILLE – You don't have to do business with the other guy, representatives of Blue Cross Blue Shield NC and Mission Health, two organizations locked in a contract dispute, told a business group Friday.

Most of the dollars Blue Cross NC paid for claims in WNC over the last year went to providers that are not part of Mission, said Steve Crist, vice president for group markets at the insurer.

"We are encouraged by the access that remains outside of the Mission Health system," he told the Council of Independent Business Owners.

"Both Cigna and Aetna are convinced that their arrangements will make them very competitive in the employer market," he said in remarks targeted to people in the crowd who buy insurance for their employees. "They would be more than happy to work with you on a new (insurance) agreement. ... You should talk to your broker about your options."

Mission has terminated its contract with Blue Cross NC, effective Oct. 5. The move touched off worries among thousands of WNC residents with Blue Cross insurance who would have to pay higher, out-of-network rates for care at Mission if the dispute is not resolved

Mission said it had to act because Blue Cross NC would not budge off its offer of no rate increase during months of talks and its current contract would keep payments from Blue Cross NC flat if not cancelled.

Blue Cross NC says it is offering no increase in an effort to slow rising costs for health care. It says it won't negotiate with Mission until the health system rescinds the termination.

"A termination notice is not the beginning of a negotiation, it's the end of a negotiation," Crist said Friday. Mission's offer to keep talking "is as if a spouse serves divorce papers and then is asked to go to marriage counseling," he said.

Yeatman said the terms of Mission's current contract left it with no alternative and Blue Cross NC can resume talks if it wants.

"It's their policy and their choice" to end negotiations, he said. "Mission could not allow an automatic renewal at zero percent (rate increase), but we will continue negotiations anywhere and at any time and any place."

Crist listed four areas of care – family medicine, radiology in a free-standing clinic, cardiovascular disease and orthopedic surgery – in which he said providers other than Mission accounted for more than half the claims dollars Blue Cross NC paid in 16 WNC counties.

Buncombe County Commissioner Mike Fryar said Mission has too much control over the health care system in the county.

"Mission has bought everything up. They bought all the doctors, they bought everything in this town," he said. "I have no place to go."

Yeatman said he has been involved in every transaction in which Mission has acquired medical practices over the past six years and in all but two, the entity acquired initiated the conversations.

"We did those partnerships so we could preserve those services," he said.

Many health care providers in the area face the same challenge Mission does, he said: A low percentage of patients with private insurance that offers reasonable reimbursement and a high percentage on Medicare and Medicaid, which do not.

Fryar was one of several in the audience who complained Mission charges too much.

After Yeatman ticked off a list of high rankings and awards Mission has won, Tom Van Slambrouck said, "Some of those aren't very relevant when you have people who can't even afford your services."

Yeatman said Mission's prices compare well with its peers'. He said there is an inconsistency between Blue Cross NC's request for no increase in the rates it pays Mission and the rising rates it charges those it insures.

He cited a recent statement by a spokesman for the insurer that the annual percentage increase in the rates Blue Cross NC charges employers has been in the mid-single digits this year.

"I may not be that great at math, but it seems like there's some extra money somewhere," Yeatman said.

Crist attributed at least some of the change in Blue Cross NC rates to higher costs for prescriptions and increased utilization of services.